P1-198 Study of spatial distributions and effect of the patient distance from health center on default and interrupted therapeutic outcomes in tuberculosis disease using GIS and GPS, IN Urmia, Iran, during 2004-2009

Abstract

Objective Comparison of active vs passive primary healthcare function in rural with urban setting at determine of delay to diagnosis and treatment of tuberculosis and its outcomes in West Azerbaijan province, Iran, at 2004e2009. Material and Methods In this perspective study we used years TB new cases data that have been recorded by TB management center in West Azerbaijan province. Patient and health system delay were determined as number of days between onset of symptoms to diagnosis and diagnosis to start of treatment respectively. Results At comparison of domicile, both of patient and health delay mean days were more in urban patients (respectively 241 vs 133, p value¼0.02 and 11 vs 7, p value¼0.006). In rural patients, females at comparison of males had more mean total time delays (163 vs 115, p value¼0.01). Despite of higher mean of total delays in extra pulmonary to pulmonary at both of domicile (respectively urban 278 vs 232 and rural 197 vs 97), there was significantly difference in rural regions (p value¼0.0001). Default rate in rural regions was less than urban settings (respectively 3.53% vs 6.08%) and whereas success rate was more than it (respectively 81% vs 79%). Conclusion At regard to health system policy in Iran that primary healthcare for tuberculosis in rural regions is active whereas urban setting is passive, it seems there is urgent need to change of policy in case finding and case holding of patients in urban area to decrease time delays and increase positive outcomes. Objective To determine of the spatial distributions of tuberculosis (TB) and effect of patient distance from the health center on default or interrupted therapeutic outcomes in Urmia, Iran, during 2004e2009. Material and Methods In this cross sectional study we used the data of 452 new TB cases, which have been recorded by TB management center in Urmia, capital of West Azerbaijan province, during a fiveyear period. In order to identifying the significant geographical clusters, we used the "Average Nearest Neighbour" method. Linear regression method was used to determine linear correlation between patients distance and number of default and interrupted therapeutic outcomes. Results Five countryside areas had significantly spatial clusters of TB (p<0.0001). As the distance of patient from TB health center are increased, the number of the default and interrupted cases were also increased (r 2 ¼0.25, p¼0.04). In comparison with the number of default and interrupted cases and the mean distances of TB health center, wherever mean distance was more than 1 Km, number of default and interrupted cases were more than 3 (p¼0.02). Conclusion Spatial distributions of tuberculosis disease in Urmia are not randomly and suburban areas need more serious attentions by policy makers and health planners. According to the health system in Iran, health posts has not actively role in treatment of TB patients at urban settings. As a result, if the health posts are contributed to in the TB treatment programs, the patient distance from the treating he...

Comprehensive benefit analysis of geographic information monitoring and early warning system for disaster prevention and reduction in rural areas: simulation experiment based on system dynamics

“…Secondly, the rescue time is the decisive factor in the rescue process, and the geographic information monitoring system is the most effective to provide the initial rescue information [3]. After a disaster, time is life.…”